Research: Epidural Steroid Injections Provide No Significant Relief for Back & Leg Pain
Conservative care is recommended first.
MedPage Today reports on a study published in the Annals of Internal Medicine:
Epidural injections provided modest short-term pain relief from lumbosacral radiculopathy, whether used with steroids or the anti-inflammatory biologic etanercept (Enbrel), a clinical trial showed.
Neither treatment reduced leg or low back pain significantly compared with saline injections at one month, Steven P. Cohen, MD, of Johns Hopkins, and colleagues reported in the April 17 issue of the Annals of Internal Medicine.
Etanercept actually appeared to retard improvement in disability, as functional capacity improved similarly with steroids or the saline placebo (P=0.23), but not with the monoclonal antibody (P=0.04 versus saline)...
The confluence of little relief from analgesics and unproven long-term benefits from surgery for acute radicular symptoms "has led to a soaring increase in epidural steroid injections, but this treatment is mired in controversy," Cohen's group wrote.
Steroid injections are nearly universally acknowledged as effective in certain contexts, but long-term efficacy results are mixed and reports of catastrophic consequences like spinal cord infarction are burgeoning, they explained...
The researchers noted further research is needed to better determine whether these injections are beneficial for back and leg pain. They noted additional studies should be larger and longer-term. Read the rest of the article here.
Current treatment guidelines for low back pain recommend patients first try conservative care like chiropractic, or acetaminophen and NSAIDs unless there is an emergency. Signs of emergency include loss of bowel/bladder control or severe numbness/weakness of the legs.
Epidural injections provided modest short-term pain relief from lumbosacral radiculopathy, whether used with steroids or the anti-inflammatory biologic etanercept (Enbrel), a clinical trial showed.
Neither treatment reduced leg or low back pain significantly compared with saline injections at one month, Steven P. Cohen, MD, of Johns Hopkins, and colleagues reported in the April 17 issue of the Annals of Internal Medicine.
Etanercept actually appeared to retard improvement in disability, as functional capacity improved similarly with steroids or the saline placebo (P=0.23), but not with the monoclonal antibody (P=0.04 versus saline)...
The confluence of little relief from analgesics and unproven long-term benefits from surgery for acute radicular symptoms "has led to a soaring increase in epidural steroid injections, but this treatment is mired in controversy," Cohen's group wrote.
Steroid injections are nearly universally acknowledged as effective in certain contexts, but long-term efficacy results are mixed and reports of catastrophic consequences like spinal cord infarction are burgeoning, they explained...
The researchers noted further research is needed to better determine whether these injections are beneficial for back and leg pain. They noted additional studies should be larger and longer-term. Read the rest of the article here.
Current treatment guidelines for low back pain recommend patients first try conservative care like chiropractic, or acetaminophen and NSAIDs unless there is an emergency. Signs of emergency include loss of bowel/bladder control or severe numbness/weakness of the legs.